Opinion editor's note: editorial They represent the opinion of the Star Tribune Editorial Board, which operates independently of the newsroom.
•••
Now is probably not the right time to end reimbursement for mental health providers in Minnesota. But there are times when it's especially difficult, and this is one of them.
From 2005 to 2023, the number of licensed beds in pediatric residential treatment facilities across the state decreased from 2,474 to 1,586, according to Aspire MN, a St. Paul-based advocacy group. Earlier this week, doctors at Children's Minnesota, the state's largest pediatric health system, laid out the harmful effects of this decline in a press conference.
“In 2023, 12,000 children were admitted to hospitals across the state. All children admitted to Children’s Minnesota did not have access to appropriate mental health treatment. He spent more than 1,600 days in the hospital,” said Dr Jiji Chawla, vice chancellor and chief of general pediatrics. At Children's.
Adult mental health providers are also struggling, with North Memorial Health recently announcing it would close its outpatient mental health services at Robbinsdale Medical Center in August.
If the Minnesota Legislature does not act this session, the reckless reimbursement cuts passed last year will soon make this long-term care crisis even worse. That's an outcome they should work quickly to avoid.
States need more care options for people suffering from mental illness, not fewer. But that's probably what will happen if the mistakes lawmakers made in 2023 are not corrected.
The error occurred when lawmakers too quickly passed a policy that cut off critical access payments to mental health clinics and health care providers. The changes will take effect Jan. 1, 2025, and will total more than $25 million over three years, according to the Minnesota Mental Health Legislative Network, a consortium of about 30 state health care providers and advocacy groups.
The fee surcharge has been in place since 2007 and was a stopgap measure to address a chronic problem of low reimbursement rates for patients enrolled in Medicaid, the joint federal and state health care assistance program for the poor. considered as a treatment. In Minnesota, this program is known as Medical Assistance and MinnesotaCare.
Low reimbursement is a problem for all health care services for public program enrollees, but it is especially acute when it comes to mental health.
Many people who qualify for Medicaid suffer from mental illness or addiction. “In 2020, nearly 40% of the nonelderly adult Medicaid population (13.9 million enrollees) had a mental health disorder or substance use disorder (SUD),” the reputable bipartisan health care The policy organization KFF reports.
As a result, Medicaid has become “the single largest payer for mental health services in the United States,” federal officials said.
KFF estimates Minnesota's Medicaid enrollment at 1.4 million. Therefore, the sunset cuts will be widely felt by mental health providers whose operating margins are already thin because their clientele includes many Medicaid enrollees. That would put the onus on state legislatures, which set the reimbursement, to delay or eliminate sunset in 2023.
“Mental health provider organizations like ours rely on critical access payments to cover current program-related costs,” said the CEOs of six Minnesota mental health providers. This includes wages, benefits, and other program-related costs such as interpreters.'' This week I'm on the editorial board.
The Minnesota Hospital Association (MHA) also weighed in, noting that inaction will impact the state's entire health care system. The industry group said a lack of community-based mental health treatment has made the state's nonprofit health system “the primary provider of mental health services,” resulting in long wait times for treatment. , found that emergency room admissions occur and the risk of death increases. Staff who care for patients in environments not designed for this type of care.
To be fair, in 2023, lawmakers passed a 3% increase in mental health provider fees for state program enrollees. However, it was far from enough to make up for the shortfall in health care costs and reimbursement for health care providers.
The apparent logic behind cutting off critical access funding was that lawmakers would return in 2024 after the release of a state report on mental health care rates and make further amendments based on the report's findings. .
That report came out in January. This makes it clear that state-provided reimbursements do not keep up with inflation and do not cover, or in some cases even come close to, the costs of providing care. In one case, the study recommended nearly tripling the amount of reimbursement for residential care provided to people suffering from addiction.
But adjusting rates as the study recommends comes at a steep price. If implementation began in 2025, it would cost the state about $820 million over three years, according to estimates from the state Department of Human Services. After implementation, these costs will cost him approximately $300 million to $400 million per year.
This price tag is likely to be the main reason why there is no broader interest rate reform this year, when austerity is a priority. You will need fortitude to tackle the upcoming sessions.
Until then, there is no point in further lowering mental health costs. At the very least, other workarounds should be found to delay or eliminate sunsets, and additional emergency relief for mental health providers should also be seriously considered.
The editorial board includes David Banks, Jill Barkham, Scott Gillespie, Dennis Johnson and John Rush. Star Tribune Opinion staff members Maggie Kelly and Elena Neuzil are also contributing, and Star Tribune CEO and publisher Steve Grove is serving as an advisor to the board.
